Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.25 / $149.60 / $321.33	Facility	26	$109.25	$149.60	$321.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $265.95 / $494.18 / $1,542.43	Professional		$265.95	$494.18	$1,542.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.66 / $140.00 / $322.00	Professional	26	$69.66	$140.00	$322.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $120.46 / $237.50 / $372.06	Professional	52	$120.46	$237.50	$372.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $188.15 / $335.00 / $631.87	Professional	TC	$188.15	$335.00	$631.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $253.83 / $552.16 / $831.11	Professional		$253.83	$552.16	$831.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.31 / $124.51 / $202.58	Professional	26	$68.31	$124.51	$202.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $183.67 / $429.11 / $654.22	Professional	TC	$183.67	$429.11	$654.22
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $457.76 / $525.27 / $628.67	Professional		$457.76	$525.27	$628.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $131.80 / $152.37 / $177.35	Professional	26	$131.80	$152.37	$177.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $321.92 / $372.90 / $451.33	Professional	TC	$321.92	$372.90	$451.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $381.62 / $537.94 / $853.02	Professional		$381.62	$537.94	$853.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.94 / $139.28 / $210.45	Professional	26	$109.94	$139.28	$210.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $260.45 / $370.95 / $726.39	Professional	TC	$260.45	$370.95	$726.39
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $102.41 / $135.85 / $140.03	Facility	26	$102.41	$135.85	$140.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.62 / $119.70 / $146.63	Professional	26	$83.62	$119.70	$146.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $313.50 / $470.80 / $652.00	Professional	TC	$313.50	$470.80	$652.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $391.46 / $585.45 / $794.38	Professional		$391.46	$585.45	$794.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.48 / $125.83 / $202.58	Professional	26	$71.48	$125.83	$202.58
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $281.11 / $281.11 / $284.64	Professional	52	$281.11	$281.11	$284.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $186.85 / $424.67 / $654.22	Professional	TC	$186.85	$424.67	$654.22
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $429.12 / $580.09 / $781.05	Professional		$429.12	$580.09	$781.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $123.89 / $147.16 / $196.13	Professional	26	$123.89	$147.16	$196.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $305.24 / $411.07 / $622.15	Professional	TC	$305.24	$411.07	$622.15
United Facility/Professional Professional Modifier Low / Median / High Price $229.76 / $449.40 / $774.16	Professional		$229.76	$449.40	$774.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.53 / $93.23 / $215.00	Professional	26	$63.53	$93.23	$215.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.95 / $321.97 / $559.16	Professional	TC	$165.95	$321.97	$559.16